SURFACE TOPOGRAPHY

Location of the abdomen:

It is part of the trunk located inferior of the
thoracic cavity, and superior to the pelvis (pelvic
cavity)

CONTENTS OF 4-QUADRANT PATTERN

Right Upper Quadrant:

 Liver
 Gallbladder
 Duodenum
 Head of pancreas
Abdominal cavity is surrounded by  Right kidney and Adrenal gland
musculomembranous walls. Superiorly, it is  Hepatic flexure of colon
bounded by the diaphragm; inferiorly, it is  Parts of transverse and ascending
bounded by the pelvic inlet. The contents of colon
abdominal cavity are peritoneal cavity, and
abdominal viscera. Right Lower Quadrant
 Caecum/ Cecum
SURFACE TOPOGRAPHY is used to describe:  Appendix
 Arrangement/ location of abdominal  Right ovary and tube
organs  Right ureter
 Pain associated with abdominal problems
Left Upper Quadrant
2 SCHEMES:  Stomach
 Four quadrant patterns  Spleen
 Nine-region pattern  Left lobe of liver
 Body of pancreas
Four quadrant patterns have 2 planes that  Left kidney and adrenal gland
divides for it to be a 4-quadrant pattern which  Splenic flexure of colon
includes Horizontal plane or transumbilical  Parts of transverse and descending
plane (Anteriorly, the land mark is umbilicus; colon
posteriorly, intervertebral disc between L3 and
L4), Vertical median plane.
 Left Lower Quadrant
 Part of descending colon
 Majority of small intestine
 Sigmoid colon
 Left ovary and tube
 Left ureter
 Rectum

TRANSPYLORIC PLANE

9-REGION PATTERN have 2 horizontal planes and 2

vertical planes

2 HORIZONTAL PLANES:
 Subcostal plane- superior horizontal
plane. Inferior to the costal margins.
Anteriorly is lower border of the costal
cartilage of rib 10. Posterior is the body of
vertebra L3.
 Intertubercular plane- inferior horizontal
plane. Connects the tubercles of the iliac
crest. Posteriorly it passes through the
upper part of the body of vertebra L5.
There are times na instead of subcostal plane, ang
ginagamit na horizontal line superiorly is
TRANSPYLORIC PLANE. It is located at the middle
(medial) of the suprasternal notch (manubrium)
(Approximately between T2-T3 of thoracic
vertebrae) and pubic symphysis (joins 2 pelvic
bones sa harap). Approximately at the level of the 1 st
lumbar vertebra. There are times na ginagamit ang
subcostal plane and there are times na ginagamit
ren ang transpyloric plane. However, mas madalas
gamitin ang subcostal plane.
VERTICAL PLANE- passes from the midpoint of UMBILICAL REGION
the clavicles. Midway between the anterior  Duodenum
superior iliac spine and the pubic symphysis.  Majority of the Small
intestine
 Transverse colon

LEFT LUMBAR REGION

 Most of the Descending
colon
 Small intestine
 Left kidney

RIGHT ILIAC REGION

 Appendix
 Cecum
 Ascending colon
 Small intestine

HYPOGASTRIC REGION
 Urinary bladder
 Most of the Sigmoid colon
9 REGIONS AND THE ORGANS THEY  Small intestine (located
CONTAIN: anywhere in right and left
lumbar; right and left iliac;
RIGHT HYPOCHONDRIAC REGION: umbilical and hypogastric
 Liver region)
 Right kidney  Reproductive organs
 Gallbladder  Rectum
 Large and small intestine (konti lang)
LEFT ILIAC REGION
EPIGASTRIC REGION:  Sigmoid colon
 Liver  Descending colon
 Majority of the Stomach  Small intestine
 Spleen
 Duodenum
 Adrenal glands
 Pancreas

LEFT HYPOCHONDRIAC REGION:

 Liver’s tip
 Stomach (some parts)
 Pancreas
 Left kidney
 Most of the Spleen
 Small portions of large and small
intestine

RIGHT LUMBAR REGION

 Most of the Ascending colon
 Small intestine
 Right kidney
ABDOMINAL WALL (ANTEROLATERAL) 7. Internal oblique
Transverse section of human torso to see the 8. Deep investing fascia
walls of abdomen. Anterior and lateral wall are 9. Transversus fascia
called anterolateral abdominal wall. 10. Transversalis abdominis
11. Extraperitoneal fat
Anterolateral abdominal wall boundaries: 12. Parietal peritoneum
superiorly, it is bounded by the xiphoid process
of the sternum and the costal cartilages of ribs
7, 8, 9, and 10. Inferiorly, it is bounded by the
inguinal ligament

2 classifications of muscles in the anterolateral

abdominal wall

 FLAT MUSCLES
 External oblique (orientation:
hands on pocket)
 Internal oblique (orientation:
parang niyayakap ang sarili)
 Transversus abdominis
 LONGITUDINAL/ VERTICAL
MUSCLE
 Rectus abdominis
 Pyramidalis

Layers of the anterolateral abdominal wall

from superficial to deep
1. Skin
2. Camper fascia (Subcutaneous fat)-
major site of fat storage in the
abdominal area
3. Scarpa fascia
4. Superficial investing fascia
5. External oblique
6. Intermediate investing fascia
Aponeuroses are sheets of fibrous
tissue that anchor muscles to bone, deep
fascia, or other muscles. The fibers of flat
muscles plus transversus abdominis
continue laterally and medially to form
aponeuroses. The attachment at the
midline in the abdomen of the
aponeuroses is called LINEA ALBA

Rami/ramus are the 2 divisions of the spinal nerve. Ventral/

Muscles of the anterolateral abdominal rami and supply innervation to the anterior surfaces of the
wall: trunk. Posterior/ dorsal rami supply the innervation to the
posterior trunk.
 Rectus sheath
 Rectus abdominis 5 muscles na nawawala na because of evolution:
 Superior epigastric  Palmaris longus (palm)
 Inferior epigastric  Plantaris muscles
 Pyramidalis  Peroneus torsus/ fibularis torsus
 Pyramidalis
 Psoas minor- hip flexor
5 Umbilical peritoneal folds
1. Median umbilical fold- covers the
median umbilical ligament. It is a
remnant of a fetal structure which
originally connects the fetal urinary
bladder to the umbilical cord
2. Medial umbilical folds (2)- covers the
umbilical ligament. It is a remnant of
umbilical arteries
3. Lateral umbilical folds (2)- it covers
the inferior epigastric vessels
INNERVATIONS
4 primary innervations of anterolateral
abdominal wall:
Thoracoabdominal nerves- it comes from the
rami of T7-T11. This particular nerve supplies
the majority of the muscles of the of
anterolateral abdominal wall. Halos lahat ng
muscles sinusupplyan.
Subcostal nerves- it came from the anterior
rami of T12. Both thoracoabdominal wall and
subcostal nerves branch out to the anterior
and lateral cutaneous branches. Cutaneous
branch supplies the skin (anterior side and
lateral side)
iliohypogastric nerve- came from anterior rami of L1.
For the motor function, it supplies the internal oblique and
transversus abdominis muscles. Kung present ang
pyramidalis, iliohypogastric nerve din ang magsusupply.
Inferior surface
Ilioinguinal nerve- came from L1. For the motor
function, it supplies the internal oblique and transversus
abdominis muscles.
ARTERIAL SUPPLY
7 ARTERIES THAT SUPPLY BLOOD TO THE
ANTEROLATERAL SIDES OF ABDOMINAL WALL:
Superior epigastric artery- supplies blood to the
superior region of anterolateral abdominal wall. It is a
branch of internal thoracic artery.
Inferior epigastric artery- supplies blood to the inferior
region of anterolateral abdominal wall. It is a branch of
external iliac artery.
Musculophrenic artery- supplies blood to diaphragm
and right and left hypochondriac regions. It is a branch
of internal thoracic artery
Deep circumflex iliac artery- a branch of external iliac
artery. Supplies blood into the deep abdominal wall
across the inguinal region
Superficial epigastric artery- a branch of femoral
artery. It supplies blood to the superficial abdominal wall
across the inguinal region.
Superficial circumflex iliac artery- a branch of
femoral artery.
10th and 11th posterior intercostal artery and
subcostal artery- direct branches of aorta. Supplies
blood to the lateral sides of abdominal wall.
VENOUS DRAINAGE (superficial)
Superficial subcutaneous venous plexus-
drains blood from the skin. Carries blood
superomedially into the internal thoracic vein
and superolaterally into the lateral thoracic
vein.
Inferior epigastric vein and Superficial
epigastric vein- carries blood into the external
iliac vein and femoral vein
Thoracoepigastric vein- network of veins,
drains blood from the lateral sides of abdomen
VENOUS DRAINAGE (DEEP)
Superior epigastric vein and musculophrenic
vein- Superiorly, carries blood into the internal
thoracic vein
Inferior epigastric vein- carries the blood into the
external iliac vein
LYMPHATIC DRAINAGE:
SUPERFICIAL:
Superficial lymphatic vessels are above the
umbilicus, it drains lymphatic fluid into the
axillary lymph nodes and parasternal
lymph nodes.
Lymphatic vessels below/inferior the umbilicus
drains lymphatic fluids into the superficial
inguinal lymph.
DEEP:
Carry the lymph into the right and left lumbar
nodes and into the external iliac nodes and
common iliac nodes
3 major components of abdominal wall:
 Fascia layers
 Muscles
 Lumbar vertebrae

primary functions of the abdominal wall

 Protection of abdominal organs
 Provides movement
 Increases intra-abdominal pressure

dermatome is a segment of skin that transmits

sensor input to the central nervous system
either through the trigeminal (V) nerve or the
one pair of spinal nerve's posterior roots.

4 INNERVATIONS OF ABDOMINAL WALL:

 Thoracoabdominal nerves
 Subcostal nerves
 iliohypogastric nerve
 Ilioinguinal nerve

5 UMBILICAL PERITONEAL FOLDS:

 Median umbilical folds

 2 pairs of medial umbilical fold
 2 pairs of lateral umbilical folds
 Right and left umbilical folds

7 ARTERIES THAT SUPPLY BLOOD TO THE

ANTEROLATERAL SIDES OF ABDOMINAL WALL:
 Superior epigastric artery
 Inferior epigastric artery
 Musculophrenic artery
 Deep circumflex iliac artery
 Superficial epigastric artery
 Superficial circumflex iliac artery
 10th and 11th posterior intercostal artery and
subcostal artery

Lymph nodes (superficial)

 Axillary lymph nodes
 Superficial inguinal lymph nodes
 Parasternal lymph nodes

Lymph nodes (deep)

 Right and left Lumbar nodes
 External iliac nodes
 Common iliac nodes